Official Title: Evaluating the Nurse Family Partnership Program in the Commonwealth of Pennsylvania
Research Lead: David Rubin, M.D., M.S.C.E.
Study Team: Meredith Matone, M.H.S., Amanda O’Reilly, M.P.H., Xianqun Luan, M.S.
Supported by: Pennsylvania Department of Public Welfare
Dates: April 01, 2008 – February 28, 2011
Background
In March 2010, $1.5 billion was invested in home visitation programs through the Patient Protection and Affordable Care Act (PPACA). While home visitation programs are growing in popularity and receiving increasing financial support, we know little about the evidence to support improved outcomes after widespread implementation. The Nurse Family Partnership (NFP) program, a prenatal home visitation program, has been found to positively impact a variety of maternal and child outcomes, including maternal smoking cessation, a reduction in second pregnancies, improved birth weight outcomes, reduced injuries to children in their first few years of life, and reduced welfare receipt among participating mothers in multiple randomized trials. However, it is uncertain to what degree widespread dissemination and variation in individual program performance may have impact on the NFP program’s ability to improve outcomes.
Objective
- Evaluate five specific outcomes comparing NFP clients and non-participating matched controls, including:
- Low-birth weight
- Smoking cessation
- Time to second pregnancy
- TANF receipt after delivery
- Injury rates among infants during the first two years of life. Quantify agency variation in outcomes as a means to consider local-level practice improvement initiatives.
Methods
Design: This study is a retrospective cohort of NFP clients matched with non-participating, NFP-eligible women from the same geographic area using propensity score matching.
Population: The NFP population consisted of first time mothers who were receiving welfare assistance before the 28th week of pregnancy. The study sample was enrolled in one of the 23 NFP programs throughout the Commonwealth of Pennsylvania from 2000 to 2007.
Policy Implications
- Guide better evidence-based technical assistance to local NFP sites about the key program and local community elements that lead to significant differences in program outcomes
- Enhance efforts to increase NFP program effectiveness by developing a quality improvement tool that accounts for the local community elements alongside program elements used during program monitoring.
Dissemination
Matone M, O’Reilly A, Luan X, Localio A, Rubin D. Emergency Department Visits and Hospitalizations for Injuries Among Infants and Children Following Statewide Implementation of a Home Visitation Model. Maternal and Child Health Journal. Online Epub December 2, 2011. DOI 10.1007/s10995-011-0921-7.
Rubin DM, O’Reilly ALR, Luan X, Dai D, Localio R, and Christian CW. Variation in Pregnancy Outcomes Following Statewide Implementation of a Prenatal Home Visitation Program. Arch Pediatr Adolesc Med. Published online November 1, 2010. doi:10.1001/archpediatrics.2010.221
Related Resources
- Nurse-Family Partnership. 2010. http://www.nursefamilypartnership.org/.
- The PEW Center on the States. PEW Home Visitation Campaign (2010). http://www.pewcenteronthestates.org/initiatives_detail.aspx?initiativeID=52756
